Devices such as pulse oximetry to monitor hemoglobin oxygen saturation noninvasively have improved our ability to detect and remedy any deterioration in a more timely fashion. Better pain management—including the use of regional anesthesia—together with more appropriate sedation regimens has enabled us to shorten the duration of mechanical ventilation.
In acute lung injury and ARDS, the development of CT scanning has allowed a better understanding of the anatomic alterations, delineating zones of complete collapse, recruitable regions, and well-aerated regions. The conditions under which recruiting maneuvers are an effective adjunct to ventilation to improve gas exchange and when they are most likely to cause hemodynamic stress are better understood. Nevertheless, the concept of whether and how to recruit alveoli—including how to adjust PEEP levels—remains contentious.
Imagine a patient with sepsis-related ARDS in your ICU…. and now imagine how that same patient would have been managed 25 years ago. Looking back on how patients were managed in the past demonstrates clearly just how much intensive care medicine has changed! However, do these changes in intensive care medicine represent progress, and has this progress kept pace with other disciplines?
Considerable progress has been made in the development of modern respirators. The bulky giants of 25 years ago have been replaced by slim-line, portable models. The elements that impact the work of breathing during assisted ventilation are now better defined, and the performance characteristics of ventilators—valve resistance, flow delivery, and monitoring—have also been improved. These developments have increased patient comfort and have allowed earlier detection of adverse patient/ventilator interactions. Recognition of the presence and consequences of auto-positive end-expiratory pressure (PEEP) has enabled reductions in its adverse effects on hemodynamics and in work of breathing. The use of pressure support has dramatically improved the management of respiratory failure, primarily by its easy adaptation to patient needs. website